Forms and Documents

Genentech BioOncology® Access Solutions for COTELLIC and ZELBORAF Enrollment Forms

The SMN and PAN are required for enrollment in Genentech BioOncology Access Solutions.

 

Prior Authorization Checklists and Tips

Appeals Checklists and Tips

PAN=Patient Authorization and Notice of Request for Transmission of Health Information to Genentech Access Solutions and Genentech® Access to Care Foundation.

SMN=Statement of Medical Necessity.